POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050

The Patient Protection and Affordable Care Act of 2010 (ACA) is a revolutionary policy. This Act wanted to address social injustices in the American healthcare system. However, this policy has met stiff opposition from Republican legislators who openly opposed it. When Donald Trump came to power, repealing ACA was one of his number one priorities. They, however, did not get the requisite number to repeal ACA since other legislators felt like many Americans would be affected. Many Republican lawmakers started seeing that they may not get reelected if they continued to support the repeal of ACA.

In May 2017, the House of Representatives passed the American Health Care Act (Jost, 2017). This was the first attempt at repealing ACA. The Trump administration wanted to use this act to repeal ACA.  However, this Act would make millions of Americans lose health insurance coverage. AHCA proposed that tax credit be based on age, which would increase healthcare costs. This Act also created the Patient and State Stability Fund, which would reduce premiums by 25% after 2026 (Jost, 2017). This would increase healthcare costs for Americans with preexisting comorbid conditions.

A cost-benefit analysis by Republican lawmakers revealed that they would not get reelected because of the negative effects of repealing. Repealing ACA would lead to millions of Americans losing insurance coverage (Straw & Aron-Dine, 2020). This was the main reason for implementing ACA. ACA aimed to increase insurance coverage to millions of Americans and reduce healthcare costs (Sommers, 2020). Due to reelection purposes, the Senate Majority Leader McConnell found it hard to garner support for AHCA. To protect their political interest, the US senators came up with another proposal known as the Better Care Reconciliation Act of 2017 (Smith & Gibbs, 2017).

Members of Congress and Senators are elected leaders who must be voted for by the public. Due to this, their positions on policies such as Obamacare are influenced by how their electorates feel. Because of this, their interest is reelection and not ACA.

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050 References

Jost, T. S. (2017). House passes AHCA; HHS acts on regulations. Health Affairs, 36(6), 982-983.

Smith, K., & Gibbs, T. E. (2017). The APHA PHACT campaign in action in Delaware. Delaware Journal of Public Health, 3(4), 6-11.

Sommers, B. D. (2020). Health insurance coverage: What comes after the ACA? Health Affairs, 39(3), 502-508.

Straw, T., & Aron-Dine, A. (2020). Commentary: ACA Repeal Even More Dangerous During Pandemic and Economic Crisis. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/commentary-aca-repeal-even-more-dangerous-during-pandemic-and-economic-crisis

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Your post well describes the outcome of cost-benefit analysis and recognizes how it was represented regarding attempts to repeal/replace the ACA during the Trump administration. It is clear that that is no longer a threat during the Biden administration.

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10 months ago

TRINA COLEMAN 

RE: Discussion – Week 3

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The last statement of  “….their interest is re-election and not ACA.” This statement highlights the level of politics within politics. Interest groups spend resources on trying to remove legislators who do not share in their intentions. Americans would be better served by policy-motivated committees that dissect and evaluate the benefit of a bill before allowing it to be considered (Lorenz, 2020). Everything boils down to the dollar. I understand health care and politics are as much of a business as anything else. However, it is unfortunate the system is overly saturated with misguided interests, and how does this benefit me. Personal experiences weigh heavily on attitudes toward the government and health care policies within contemporary societies (Larson, 2020). Lobbyists aid in providing and identifying agendas; these “agenda setters” would be more likely to perform in the public’s best interest if a policy-motivated committee was the influence behind new bills (Lorenz, 2020).

Larsen, G. (2020. Personal politics? Healthcare policies, personal experiences and government attitudes. Journal of European Social                       Policy.

https://doi.10.1177/0958928720904319

Lorenz, G. (2020). Prioritized interests: Diverse lobbying coalitions and congressional committee agenda setting. University of Chicago Press Journals.

        https://www.journals.uchicago.edu/doi/abs/10.1086/705744

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10 months ago

Andrea Ferrin 

RE: Discussion – Week 3

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Hi Sasha, I think your discussion post was a great summary of how beneficial the ACA was and the detriment to the entire population we would have seen if the AHCA had been passed. The elderly population would have suffered the most as far as coverage due to costs, and the younger population would have had a harder time finding accessible care because of constituents based on age. Also, I like that you mentioned that health care costs would increase for Americans with comorbidities, as this has been a growing concern over the years.

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10 months ago

Colton Phelps 

RE: Discussion – Week 3

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Thank you for your response to the discussion. The way you ended your post really stands out and is a little unsettling. It is unfortunate that there are politicians who’s main goal is to keep their position or maintain their image for re-election.  I would hope that the majority of politicians stand by their ethics and vote based off their true feelings and advocate for the populations they represent. I would like to see improvements continue to be made in relation to health care without driving the costs of care up. It is obvious that politicians want to make changes, for example, the Better Care Reconciliation Act was created in order to make changes but not to be as controversial (Smith & Gibbs, 2017).

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050 References:

Smith, K., & Gibbs, T. E. (2017). The APHA PHACT campaign in action in Delaware. Delaware  Journal of Public Health, 3(4), 6-11.

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10 months ago

Amber McCarter 

RE: Discussion – Week 3

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I love that you kept the explanation of the health care acts and attempted repeal short and simple but explained it all perfectly. It is a shame that in recent times, politician’s true colors have shown. They are making it more transparent that some, unfortunately most, do not always have the American people’s best interest in mind. With legislators being driven with the primary goal of being re-elected and not solely for the benefit for its constituents (Milstead & Short, 2019), I am grateful we live in a country that allows us to be a part of a democracy in order to have some control in how our amazing country is ran. According to Dr. Nwogu, “democracy is a system of government with four key elements: a system for choosing and replacing the government through free and fair elections, active participation of the people, as citizens in politics and civic life, protection of the human rights of all citizens and a rule of law in which the laws and procedures apply equally to all citizens” (2015). I genuinely believe, if we allowed these elements to guide our country, the government wouldn’t be viewed as corrupt, and we wouldn’t have to analyze how politicians balance cost vs benefit for their gain instead of the American people like it was originally intended way back when.

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050 References

Milstead, J. A., & Short, N. M. (2019. Informing public policy: An important role for registered nurses. In Health Policy and Polictics: A nurse’s guide (6^th ed., p. 40). Jones and Bartlett Learning.

Nwogu, G. A. I. (2015). Democracy: Its Meaning and Dissenting Opinions of the Political Class in Nigeria: A Philosophical Approach . Journal of Education and Practice, 6(4). Retrieved 2021, from https://files.eric.ed.gov/fulltext/EJ1083739.pdf.

RE: In response to your Discussion – Week 3

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Good day! It was enlightening discussion of yours.

I agree that the ACA has been highly controversial despite the positive outcomes and the ACA is subject to changes every year. The legislation can be amended and budget decisions can affect how it is implemented.

The Affordable Care Act (ACA) was signed into law in March of 2010 and despite repeated attacks, not only has it survived – it has thrived and continues to provide tens of millions of Americans with access to health care coverage, because of the law, but millions of people also gained insurance coverage for the first time. Millions more have increased security when insured, benefitting from prohibitions on discrimination by insurers and protections for people with preexisting conditions.

The ACA was intended to expand options for health coverage, reform the insurance system, increase coverage for services (particularly preventive services), and provide a funding stream to improve quality of services. Has it improved coverage? Indisputably, yes. More than 20 million people have gained coverage as a result of the ACA.  It has dramatically reduced the uninsured rate.  On the day President Obama signed the ACA, 16 percent of Americans were uninsured; in March 2020, it was nine percent.  Health access?  Again, yes. The ACA’s first two open enrollment periods showed significant improvement not only in rates of coverage, but also in access to care, including access to a personal physician and medications and improved reported health status.

The ACA was passed by a Democratic Congress and signed by a Democratic president in 2010.  This political configuration lasted only for the first two years of the Obama administration. Once Republicans gained control of Congress in 2013, having campaigned on a promise to repeal the ACA, they made more than 50 attempts to eliminate the law. President Obama vetoed attempts at outright repeal, but some targeted actions were successful, as Congress made use of its appropriation power that the President either could not or chose not to fight. For example, the ACA created a Prevention and Public Health Fund, initially authorized to disburse $15 billion over 10 years.  These funds were to be used for, among other things, programs to increase access to primary care and preventive care. After Republicans gained control of Congress in 2013, they made repeated cuts to the Fund. The ACA also created a “risk corridors” program, which limited insurer profits and losses for the first three years of the program. This was intended to insulate insurers covering high needs patients from significant losses, as the ACA prohibited plans from discriminating based on health condition. When Trump took office in 2017 and Congress was under Republican control, it was widely expected that the ACA’s days were numbered. But, defying expectations, the ACA survived largely intact. One notable exception was a repeal of the financial penalty for violating the ACA’s individual mandate.

After years of neglect and sabotage, the Biden administration burst out of the gate with executive orders and proposed legislation to strengthen the ACA, and the 117th Congress passed a massive economic rescue package that includes funding to strengthen and expand the ACA’s reach and effectiveness.  Yet, an imminent decision from the Supreme Court could threaten the ACA’s success – and its very existence.

In the meantime, the ACA is the law of the land and will remain so until alternative legislation is passed. It behooves Republicans not to exacerbate the churn and disruption that has been ongoing in the exchanges until alternative legislation is in place and ready to be implemented. Controlling the White House, House, and Senate, even with precarious margins will make it difficult to convince the American public that any problems with health care aren’t the government’s  responsibility. Changes in the healthcare field along with changes to the political make up of future presidential administrations and Congress, make it likely that the ACA will continue to change for years to come.

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050 References

Beauregard, Lisa Kalimon, and Edward Alan Miller. 2020. “Why Do States Pursue Medicaid Home Care Opportunities? Explaining State Adoption of the Patient Protection and Affordable Care Act’s Home and Community-Based Services Initiatives.” RSF: The Russell Sage Foundation Journal of the Social Sciences6(2): 154–78. DOI: 10.7758/RSF.2020.6.2.07.

Duggan, Mark, Gopi Shah Goda, and Emilie Jackson. 2019. “The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes.” National Tax Journal 72(2): 261–322.

Gutierrez, Carmen M. 2018. “The Institutional Determinants of Health Insurance: Moving Away from Labor Market, Marriage, and Family Attachments Under the ACA.” American Sociological Review (6): 1144–70.

The Affordable Care Act (ACA) was enacted in 2010, and it considerably changed the U.S. health care landscape. The goals of the ACA were to make insurance coverage more affordable, reduce the number of uninsured, and expand access to care. To attain these goals, the ACA expanded eligibility for Medicaid and established new marketplaces where Americans without employer coverage could purchase policies directly from insurers (Oberlander, 2017). The ACA faced strong opposition from Republicans, who described it as unrealistic because it required every American to have medical insurance (Oberlander, 2017). When the Trump administration took power in 2017, the president and Congress members of the Republican Party vowed to replace the ACA. However, one year after taking office, Republicans could not agree on whether to repeal the ACA immediately, repeal right away and replace it later, or repeal it later after establishing a replacement strategy (Oberlander, 2017).  Although the Republicans repealed parts of the ACA, including the budgetary and fiscal provisions, they did not replace it.

The Senate Republicans’ failure to honor their promise of passing a bill to replace ACA, can be attributed to the unpopularity of this bill to the public. The legislators had to assess the political impact of repealing the ACA with no replacement on their chances of being reelected (McCarthy, 2017). They had to perform a cost-benefit analysis on the cost of repealing the ACA on the future chance of being reelected and the benefits of repealing it. For instance, if the Senate replaced the ACA right away, with no replacement, the number of uninsured Americans would increase drastically, which would be opposed by their voters (McCarthy, 2017). This would negatively affect the public view of the lawmakers on their constituents, and lower their odds of being reelected if they did not have a better plan to replace the ACA.  Besides, the cost-benefit analysis can explain why the Republicans had two canceled votes in March 2017 and had to introduce a new amendment to the American Health Care Act to unite the party behind the bill (McCarthy, 2017). The failure to replace the ACA as promised shows that lawmakers can be unwilling to support bills that are a potential threat to their election results in upcoming elections.

Legislative leaders’ decisions regarding recommending or positioning national policies are often influenced by their voters’ views. Voters are known to influence legislators’ policy choices and are at times forced to compromise their choices including partisan politicians (Pacheco & Maltby, 2017). Lawmakers have to consider their voters’ views before making a policy decision that affects their constituents to maintain a positive public image (Pacheco & Maltby, 2017). In the case the voters’ views contradict a legislator’s decision regarding a policy, the lawmaker is forced to compromise their position on the policy and move to the center.

Failing to take the voters’ views can have negative consequences on the law maker’s future elections. Furthermore, to continue supporting and voting for a legislator in future elections constituents must remain convinced that their lawmaker is listening to them and consider their views (Pacheco & Maltby, 2017). For instance, members of congress had to assess the voters’ view on repealing the ACA provisions that would cut funding for Medicaid or change Medicaid to a block grant program. Since many Americans benefited from the expansion of Medicaid, it affected Congress’ decision to pass bills that would hinder their voters’ access to the program and ultimately affect their public image.

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050 References

McCarthy, M. (2017). U.S Republican attempt to repeal and replace Affordable Care Act collapses. https://doi.org/10.1136/bmj.j3508

Oberlander, J. (2017). Repeal, replace, repair, retreat—Republicans’ health care quagmire. New England Journal of Medicine, 377(11), 1001-1003.

Pacheco, J., & Maltby, E. (2017). The role of public opinion—does it influence the diffusion of ACA decisions?. Journal of Health Politics, Policy and Law, 42(2), 309-340.https://doi.org/10.1215/03616878-3766737

   The Affordable care act was signed under President Obama in 2016. According to one-third of Americans, maintaining and enhancing the ACA is the path toward health system reform they favor (McIntyre et al., 2020). Nearly every Republican fiscal plan over the past ten years has included repealing the Affordable Care Act and making significant Medicaid cuts, increasing healthcare costs for millions of Americans (McIntyre & Song, 2019). Most Americans have accepted the ACA because there is no other choice now. Those who believe our healthcare system should include Medicare extended to all or universal care are unwilling to pay more taxes to support this effort (McIntyre et al., 2020). The loss of affordable health insurance would have negatively affected American households. Making decisions would become complicated when sick because people would have to prioritize paying for necessities such as food, shelter, and clothing (Economic Policy Insitute, 2020). 

     In agreement, there are both good and bad things from Obama Care. Smaller businesses with under 100 employees suffered financially trying to adhere to these regulations. It would seem only fair that smaller employers have some input and choices of the insurance coverage offered to their employees moving forward. Tying our health insurance to the job market complicates it because smaller employers cannot afford it. They will hire fewer people, which would also negatively affect our economy.